Healthcare Provider Details

I. General information

NPI: 1356000434
Provider Name (Legal Business Name): NEULIFE REHABILITATION OF MICHIGAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 ALLEN DR STE G
TROY MI
48083-4003
US

IV. Provider business mailing address

36975 UTICA RD STE 102
CLINTON TOWNSHIP MI
48036-1685
US

V. Phone/Fax

Practice location:
  • Phone: 586-300-5866
  • Fax:
Mailing address:
  • Phone: 502-558-8312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: PATRICK GLENN KELLEY
Title or Position: CEO
Credential:
Phone: 502-558-8312